Are You Eligible?

A client gets CCS services if the clients meets all four CCS eligibility rules:

1. Age eligible: the child is under 21 years old.

2. Medically eligible: the child has a physical disability or medical condition that is covered by CCS. This is called having a "CCS eligible condition." CCS covers many serious health and physical conditions. 

The following criteria will help you determine if your child is eligible for CCS:

• Conditions involving the heart (congenital heart disease)
• Neoplasms (cancers, tumors)
• Disorders of the blood (hemophilia, sickle cell anemia)
• Endocrine, nutritional, and metabolic diseases (thyroid problems, phenylketonuria (PKU), diabetes)
• Disorders of the genitourinary system (serious chronic kidney problems)
• Disorders of the gastrointestinal system (chronic inflammatory disease, diseases of the liver)
• Serious birth defects (cleft lip/palate, spina bifida)
• Disorders of the sense organs (hearing loss, glaucoma, cataracts)
• Disorders of the nervous system (cerebral palsy, uncontrolled seizures)
• Disorders of the musculoskeletal system and connective tissues (rheumatoid arthritis, muscular dystrophy)
• Severe disorders of the immune system (HIV infection)
• Disabling conditions or poisonings requiring intensive care or rehabilitation (severe head, brain, or spinal cord injuries, severe burns)
• Complications of premature birth requiring an intensive level of care
• Disorders of the skin and subcutaneous tissue (severe hemangioma)

3. Residentially eligible: The client is a resident of Riverside County. Each county in California has a CCS program, and if you move to another county, we will help you transfer to that county's CCS program.

4. Financially eligible:
The client has

• Medi-Cal 
  • please note If client does not have Medi-Cal they will need to apply to Medi-Cal as part of the eligibility requirment
• Family's adjusted gross income is less than $40,000 
• If over $40,000 the out-of-pocket medical expenses are expected to be more than 20 % of family's adjusted gross income for the client's CCS eligible condition.
• Diagnostic services to find out if there is a health problem covered by CCS 
• CCS Medical Therapy Program (MTU) services only 
• Was adopted with a known health problem that is covered by CCS

FEES

Some families may pay:
An annual assessment fee of $20 AND
An enrollment fee, using a sliding scale based on
family income and size.

The amount of the enrollment fee depends on how much money a family makes and how big the family is. For example, a family of three earning $40,000 will pay an enrollment fee of $300 plus the $20 assessment fee each year.

A family will not pay these fees if the child has one of the following:

1. Full-scope Medi-Cal with no Share Of Cost

2. CCS Medical Therapy Program (MTU) services only if client has IEP/IFSP

3. Was adopted with a known health problem that is covered by CCS

NOTE: A signed application form gives the family legal rights to appeal.

FAQs

What if my child has private health insurance coverage?

Your child may be eligible for the CCS program even though you have private health insurance coverage.  In general, the private insurance must be utilized first.  You must keep CCS informed of changes or termination of your private insurance benefits.

What if my child has Medi-Cal?

Children with Medi-Cal coverage, including those enrolled in Medi-Cal Managed Care Plans such as Inland Empire Health Plan (IEHP) and Molina, and who have CCS eligible medical conditions are eligible for CCS services. 

CCS will authorize services related to the qualifying CCS medical condition.  The Medi-Cal Managed Care plan will provide your child’s primary care, well child check-ups, and other treatment not authorized by the CCS program.  You must inform CCS at the time your child’s Medi-Cal coverage changes or is terminated.

CCS - How is my privacy protected?

California law requires that families applying for services be given information or how CCS protects their privacy:

To protect your privacy:

• We must keep this information confidential
• We may share information on the form with authorized staff from other health and welfare programs only when you have signed a consent form.
• You have the right to see your application and CCS records concerning you or your child. If you wish to see these records contact us. By law, the information you give CCS is kept by the program.

Other Services

Families caring for a child with a CCS-eligible condition sometimes need other kinds of help. For instance:

Maintenance and Transportation (for parents when their child is in the hospital): CCS knows that families want to be together, even in the hospital.

Sometimes we can help families in need with mileage reimbursement and/or lodging nearby. For more information and eligibility requirements, please call and ask to speak with our Social Work department.